A0671 - Incidental Intramucosal Adenocarcinoma of the Appendix Presenting as Acute Appendicitis

Anna Beck, ¹, Aastha Chauhan, MD¹, Khalid Amin, MD¹, Kevin Turner, DO^2
1University of Minnesota, Minneapolis, MN; ²University of Minnesota Medical School, Minneapolis, MN

Introduction: Intramucosal adenocarcinoma arising in an adenomatous lesion of the appendix is a rare occurrence and has never been reported in a young patient per our literature search. This report is of a 29-year-old woman with this lesion and her course.

Case Description/Methods: The patient is a 29-year-old female who presented to an urgent care with complaints of nausea and right flank pain. She was subsequently referred to our emergency department, where a CT scan showed probable appendicitis characterized by enlargement, hyperenhancement, and wall thickening. Her medical history revealed that she was currently 3 months post-partum and taking Flagyl for bacterial vaginosis, and that she had a history of protein S deficiency, asthma, and remote liver lesions that were favored to represent hemangiomas and hepatic adenomas per imaging. Her vitals and labs were normal and physical exam revealed only abdominal and right flank tenderness. She was taken for a laparoscopic appendectomy, where the appendix was described as enlarged and inflamed without perforation intraoperatively. The resected appendix was sent to pathology where upon opening they discovered a 1.7 cm yellow-tan polypoid mass in the appendiceal tip. Histologic sections showed intramucosal adenocarcinoma arising in a traditional serrated adenoma with conventional-type adenomatous dysplasia and extensive high-grade dysplasia. No invasion was identified. The patient was discharged two days later and is now scheduled for a right hemicolectomy with node dissection.

Discussion: This report has detailed the course of a young patient with intramucosal adenocarcinoma of the appendix whose presentation was consistent with acute appendicitis by symptoms, radiology, and physical exam. Although this is a rare occurrence, this case serves as an important reminder that cancer can be found in patients of any age and may surface with an atypical presentation.



Disclosures:


Anna Beck, ¹, Aastha Chauhan, MD¹, Khalid Amin, MD¹, Kevin Turner, DO². A0671 - Incidental Intramucosal Adenocarcinoma of the Appendix Presenting as Acute Appendicitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.